Labor and delivery can be a whirlwind. Even if you have the most detailed birth plan, everything might not happen as expected. For all the thought and preparation that moms give to their labor and delivery experience, they might not know as much about what happens (and their options, including Pitocin) in the immediate postpartum period.

Whether you are induced, go into labor naturally, or have a vaginal or Cesarean birth, your placenta must also come out once your baby is born (aka the third stage of labor). Women often get Pitocin immediately after the delivery of the anterior shoulder, birth of the newborn, or expulsion of the placenta to prevent excessive bleeding.^15,16 But what exactly is Pitocin, why do women get it after birth, and do you have a choice? Here is everything you need to know.

What Is Pitocin?

Pitocin is a synthetic hormone that mimics oxytocin, which occurs naturally in the human body. Besides its function in bonding, sex, trust, and romantic attraction, oxytocin plays a significant role in labor, birth, and lactation.¹

Natural oxytocin aids in reducing stress, supporting healthy mothering behaviors, and uplifting mood. It also facilitates the breastfeeding relationship. However, the effects of synthetic oxytocin, or Pitocin, have not been well-studied.²

Natural oxytocin and Pitocin are both uterotonics, meaning they cause the uterus to contract. In labor and delivery, this causes the body to expel the baby and the placenta. More specifically, these hormones stimulate the top of the uterus to contract rhythmically. This also decreases blood flow to the uterus.^3,4

Why Is Pitocin Given After Birth?

Doctors often give Pitocin once a baby’s head and shoulders are delivered. They can also provide it after you deliver the baby or placenta completely. Doctors give Pitocin to prevent postpartum hemorrhage or excessive blood loss after delivery. Postpartum hemorrhage occurs in up to 18 percent of deliveries, and the most common cause is uterine atony. Uterine atony means the uterus is not clamping down and contracting as it should after delivery. If the uterus fails to clamp and clot, its blood vessels can bleed out.^5,6

Because Pitocin causes uterine contractions, doctors often administer it before the delivery of the placenta to prevent postpartum hemorrhage. It also aids placental detachment and delivery and decreases the chance that the doctor will need to remove the placenta manually. When providers prophylactically administer Pitocin, it is called “active management of the third stage of labor.” It decreases the risk of postpartum hemorrhage by about 60 percent.⁷

How Do Doctors Administer Pitocin After Birth?

Doctors can administer Pitocin through an intramuscular injection, like a shot, or through an IV. One large study showed significantly less blood loss when Pitocin was administered through an IV. Women who received Pitocin through an IV instead of a shot were also considerably less likely to need manual removal of their placenta.⁸

Pitocin Side Effects and Risks

Water Intoxication

Large doses of Pitocin over long periods can cause water toxicity because the medication causes you to retain water by decreasing your urine output.^4,9

Blood Pressure Changes

Pitocin can cause low blood pressure, particularly when given a large IV dose at one time and after a C-section. Pitocin can sometimes have the opposite effect and cause hypertension or high blood pressure.^4,10,11

Nausea and Vomiting

Pitocin may cause an upset stomach and can lead to vomiting.⁹

Postpartum Depression

One study showed an association between Pitocin administration during labor and delivery and increased postpartum depression symptoms. However, this does not necessarily indicate that Pitocin caused this increased risk. More traumatic labor that requires more Pitocin administration might increase the risk for postpartum mood disorders.¹²

Alternatives to Pitocin

Expectant Management

Expectant management means only intervening if necessary and allowing the body to naturally continue with the delivery of the placenta and clamping of the uterus. After birth, natural oxytocin surges to increase uterine contractions postpartum. Natural oxytocin works best without interference from induction, epidural, other pharmaceutical pain management, or stress and anxiety. Therefore, many providers only recommend expectant management during low-intervention births.¹¹

Uterine Massage

After delivery, your provider may massage and compress your uterus with one hand on your abdomen and the other inside your vagina. Studies have shown this technique significantly reduces blood loss in the hours immediately following delivery.^4,13

Breast Pump Stimulation

One study compared Pitocin administration with using a breast pump intermittently for 10-minute intervals during the third stage of labor. The breast pump was as effective as Pitocin administration at preventing or managing postpartum hemorrhage and did not affect pain or breastfeeding success.¹⁴

Other Pharmaceutical Interventions

Doctors sometimes use other medications to prevent and treat postpartum hemorrhage as a substitute for or in addition to Pitocin. These include Carboprost, Methylergonovine, and Misoprostol. All these medications work similarly, causing the uterus to contract and blood vessels to constrict. Most have similar side effects of nausea, vomiting, diarrhea, hypertension, fever, and shivering.⁴

Is Pitocin Required?

No. The American College of Obstetricians and Gynecologists, which is the standard of care, recommends Pitocin; however, you always have a choice regarding your medical treatment.¹⁵ While several professional organizations recommend the routine administration of Pitocin to prevent postpartum hemorrhage, it is not mandatory, and you can opt out of it. If you are at low risk for postpartum hemorrhage, you can talk to your provider about holding off on routine Pitocin. High-risk groups for postpartum hemorrhage include labor induction or augmentation, having a large baby, having an infection, or being obese. The use of Pitocin is strongly recommended for these individuals.¹⁵

If you show signs of postpartum hemorrhages, such as high heart rate, low blood pressure, nausea, chest pain, or low urine output, Pitocin is typically the first line of treatment to stop or slow your bleeding.¹⁷ Your doctor can continually reassess its use as your delivery and postpartum experience progress.

While Pitocin is great at preventing postpartum hemorrhage, it may have side effects and might not be necessary. There are nonpharmacological alternatives that may be just as effective. Depending on your birth type and risk level, it could be worth talking to your provider about holding off on this intervention.